Chest pain

Chest pain is discomfort or pain that you feel anywhere along the front of your body between your neck and upper abdomen.

Alternative Names

Chest tightness; Chest pressure; Chest discomfort

Common Causes

Heart problems that can cause chest pain:

Angina is a type of heart-related chest pain. This pain occurs because your heart is not getting enough blood and oxygen. The most common symptom is chest pain that occurs behind the breast bone or slightly to the left of it. It may feel like tightness, heavy pressure, squeezing, or crushing pain. The pain may spread to the arm, shoulder, jaw, or back.

Heart attack pain can be similar to the pain of unstable angina, but more severe.

Inflammation or infection in the tissue around the heart (pericarditis) causes pain in the center part of the chest.

Lung problems that can cause chest pain:

A blood clot in the lung (pulmonary embolism), collapse of a small area of the lung (pneumothorax), or inflammation of the lining around the lung (pleurisy) can cause chest pain that usually feels sharp, and often gets worse when you take a deep breath or cough.

Asthma generally also causes shortness of breath, wheezing, or coughing.

Pneumonia causes chest pain that usually feels sharp, and often gets worse when you take a deep breath or cough.

Other causes of chest pain:

Anxiety and rapid breathing

Inflammation where the ribs join the breast bone or sternum (costochondritis)

Shingles (inflammation/infection of the nerve that causes sharp, tingling pain on one side that stretches from the chest to the back)

Strain or inflammation of the muscles and tendons between the ribs

Chest pain can also be related to the following digestive system problems:

Stomach ulcer or gastritis (burning pain occurs if your stomach is empty and feels better when you eat food)

In children, most chest pain is not caused by the heart.

Home Care

For many causes of chest pain, it is best to check with your doctor or nurse before treating yourself at home.

If injury, overuse, or coughing have caused muscle strain, your chest wall is often tender or painful when you press a finger at the location of the pain. This can often be treated at home. Try acetaminophen or ibuprofen, ice, heat, and rest.

If you know you have asthma or angina, follow your doctor's instructions and take your medications regularly to avoid flare-ups.

You have sudden crushing, squeezing, tightening, or pressure in your chest.

Pain radiates to your jaw, left arm, or between your shoulder blades.

You have nausea, dizziness, sweating, a racing heart, or shortness of breath.

You know you have angina and your chest discomfort is suddenly more intense, brought on by lighter activity, or lasts longer than usual.

Your angina symptoms occur at rest.

You have sudden sharp chest pain with shortness of breath, especially after a long trip, a stretch of bedrest (for example, following an operation), or other lack of movement that can lead to a blood clot in your leg.

Know that your risk of heart attack is greater if you have a family history of heart disease, you smoke, use cocaine, are overweight, or you have high cholesterol, high blood pressure, or diabetes.

Call your doctor if:

You have a fever or a cough that produces yellow-green phlegm.

You have chest pain that is severe and does not go away.

You are having problems swallowing.

Chest wall pain persists for longer than 3 to 5 days.

What to expect at your health care provider's office

Emergency measures will be taken, if necessary. Hospitalization will be required in difficult or serious cases or when the cause of the pain is unclear.

The doctor will perform a physical examination and monitor your vital signs (temperature, pulse, rate of breathing, blood pressure). The physical examination will focus on the chest wall, lungs, and heart. Your doctor may ask questions like the following:

Is the pain between the shoulder blades? Under the breast bone? Does the pain change location? Is it on one side only?

More complex tests may be required, depending on the difficulty of diagnosis or the suspected cause of the chest pain.

Considerations

Many people with chest pain fear a heart attack. However, there are many possible causes of chest pain. Some causes are not dangerous to your health, while other causes are serious and even life-threatening.

Any organ or tissue in your chest can be the source of pain, including your heart, lungs, esophagus, muscles, ribs, tendons, or nerves. Pain may also spread to the chest from the neck, abdomen, and back.

Anderson JL, Adams CD, Antman EM, et al. ACC/AHA Guidelines for the Management of Patients With Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Unstable Angina). Circulation. 2007;116:803-877.

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